Abstract Number: Esoc2026a28 Impact of Intravenous Thrombolysis on the Risk of Post-Stroke Seizures: An Ambispective Cohort Study From India

Abstract Background and aims While IV thrombolysis is the cornerstone of acute ischemic stroke (AIS) treatment, its impact on the development of post-stroke seizures (PSS) and epilepsy (PSE) remains poorly understood, with conflicting results from studies. This ambispective study compared the frequency of PSS and PSE, identified risk factors, and evaluated the SeLECT score in patients with AIS managed with and without IV thrombolysis. Methods We recruited adults (≥18 years) with acute ischemic stroke (NIHSS ≥5) managed with and without IV thrombolysis with groups matched for age, gender, and vascular territory.Exclusion criteria were prior epilepsy or intracranial pathology. Primary outcomes were frequency of late PSS/PSE (7 days); secondary outcomes included early PSS (≤7 days), associated factors and SeLECT score performance.Data was collected retrospectively (Jan 2018-Jul 2023) and prospectively (Aug 2023-Dec 2024). Results Among 422 participants (203 thrombolysis, 219 controls), PSS occurred in 56(13.3%) Early PSS in 19(4.5%), Late PSS in 37 (8.8%). The frequency of PSE was 9.7%. Thrombolysis was associated with a significantly lower incidence of both early PSS (2% vs. 6.8%, p0.05) and PSE (4.9% vs. 14.2%, p0.05). Independent predictors for early PSS were thrombolysis (OR=0.185) and NIHSS at admission (OR=0.87). For PSE, independent predictors were age (OR=1.04), alcohol use disorder (OR=2.98), MCA involvement, and thrombolysis (OR=0.17). Conclusions Intravenous thrombolysis is associated with reduced risks of early and late PSS/PSE. Stroke location, alcohol use, and surgical intervention modulate seizure risk.These findings suggest a protective effect of thrombolysis, highlighting its dual benefit for improving stroke outcomes and mitigating seizure-related complications. Conflict of interest Jayaram Saibaba: Nothing to disclose, Pradeep Nair: Nothing to disclose, Sunil K Narayan: Nothing to disclose, Mahadevan D: Nothing to disclose